Category: bladder and kidney problems

The best sample is a mid-stream sample (a urine sample) collected by placing a suitable container (a small bowl or dish) under the stream of urine whilst your pet wees. However this is almost always extremely difficult to do in cats. You may be able to catch your cat out by using a long handled collecting pot. Attach a pot, for example a clean yoghurt carton, to a stick or broom handle using sticky tape. Once your cat starts to wee, move the carton under the stream of urine to collect the sample.

It is important not to use jars that have previously contained jam or honey as these can affect the test results.

In most cases your vet will only need a few teaspoons of urine to perform all the tests. If a larger sample is needed your vet will tell you.

Often the only way to collect a sample from a cat is to allow it to wee in peace in a tray and then collect the sample from the tray. Place some non-absorbent cat litter (glass beads or fish tank gravel) in the clean and dry litter tray and confine your cat in a room with the tray. Once your cat has used the tray suck up some urine from the tray with a pipette or a syringe and squirt it into a pot for storage. When you take the sample to the vet always tell them how you collected the sample as this may affect the tests your vet can do.

Some cats are extremely unwilling to wee anywhere except outside. If you really cannot get a urine sample your vet will probably suggest that they take your pet into the hospital and collect the sample for you. Samples can be collected directly from the bladder using a catheter passed up the urethra or via a needle placed into the bladder through the stomach wall. Both these procedures are simple and carry few risks for your pet.

Pour the sample into a clean, screw-topped container; write your cat’s name, your name and address and the date the sample was taken on the jar. If you can’t take the sample to the vets immediately, it is best to store it in the fridge for a maximum of 12 hours.

Damage to the cells which filter natural poisons (the normal waste produced by the body’s internal processes) out of the blood for removal in the cat’s urine is a normal ageing process. In time, so much kidney tissue is affected that these waste products can no longer be eliminated and build up inside the blood stream. This condition – which vets call chronic renal failure – is very common in cats over seven years old.

Inherited defects (particularly in long-haired breeds), bacterial infections, viral diseases like Feline Leukaemia or Feline Infectious Peritonitis, poisoning and the growth of cancers can make the damage worse.

Sudden or acute kidney failure can also occur as a result of poisoning, bacterial and viral infections, blockage of the tubes leading from the kidneys to the bladder or heart disease. These cases need emergency care and, even if successfully treated by your vet, your cat may still suffer long term kidney damage.

The kidneys have a lot of spare capacity for filtering blood, so symptoms only appear when about three-quarters of the kidney cells have stopped working.

One of the first indications of disease is the loss of ability to produce concentrated (dark) urine. So to get rid of the same quantity of waste material your cat has to produce larger quantities of more diluted urine. Your cat will be thirstier than usual and have to pass urine more often.

As the disease gets worse other symptoms may appear. Your cat may seem depressed and lose interest in food, vomit regularly, lose weight and its coat becomes dull. You may also notice bad breath and ulcers in its mouth. In the very final stages of the disease your cat may go into a coma.

Many of these symptoms also occur in other diseases such as diabetes. Your vet will want to test samples of blood or urine or perform X-rays or ultrasound examination of your cat to show that the kidneys are not working properly.

Although damaged kidneys cannot be repaired there is much that can be done to make your cat feel better. Many cats that are producing abnormally large amounts of urine become severely dehydrated. Your vet will want to give extra fluids to counter this and give medication to treat the secondary effects of the disease, such as mouth and stomach ulcers.

Damaged kidneys may be unable to get rid of waste products from the body and this may cause kidney or bladder stones. Anaemia is a common problem in cats with advanced disease and in some cats this may be treated.

The most important thing in helping your cat is to reduce the work load on the remaining healthy kidney tissue. This can be done by altering your cat’s diet. There are special diets available from your vet which reduce the waste products in the blood. They also have extra amounts of some vitamins and minerals.

Avoid giving your cat leftovers or treats which may interfere with the new diet. Affected cats often feel sick and lose interest in their food. It may help if you warm up the food to stimulate your cat’s sense of smell or hand feed it while it is getting used to the new food. Feed it ‘little and often’ and throw away uneaten food.

Always make sure your cat has plenty of fresh, clean water at all times, allowing your cat to go thirsty will make the problem rapidly worse.

If the damage to the kidneys is related to ageing, your cat may live for several years after diagnosis. As with other diseases, if you can keep your cat comfortable there is a good chance that it will survive for many months.

Your cat will need regular check ups by your vet and possibly changes to its medication. By weighing your cat often, watching its behaviour and checking how much food and water it consumes, you will be able to provide your vet with valuable information which helps to control the disease.

Domestic cats are descended from cats which hunted in the arid regions of North Africa and the Middle East and so are adapted for acquiring most of their water from their diet without the need to drink. Commercially prepared diets often contain less water than natural ones but many cats do not drink enough water to make up for this.

In up to half of cats with FLUTD it is very difficult to be sure of the cause of the disease. However, a number of factors appear to increase the risk, such as:

• Stressful experiences such as moving house may trigger problems in susceptible cats.
• Diet – mineral balance, urine pH and water intake may all affect the risk of the disease.
• Infection may produce swelling and the formation of pus which can block the cat’s urine tubes (ureter and urethra). Diabetes and some viral diseases may make cats more vulnerable to infection.
• Obesity – problems are more common in overweight and inactive cats which are often too lazy to go outside to toilet frequently.
• Urine retention – cats who, for some reason, hold their urine for long periods, i.e. do not go to the toilet frequently may be at greater risk of developing bladder stones.
• Anatomical abnormalities or tumours may make it difficult for some cats to pass urine.

Neutered male cats are the most likely to develop blockages in the urethra, the tube which runs from the bladder to the penis. But the condition can also occur in un-neutered males and females.

The urethra is longer and narrower in males than females, which seems to increase the risk of it becoming blocked by inflammation or stones in the urine. The disease is more common in young cats and the risks decrease with age. Affected cats are often between two and six years old.

If your cat is suffering from FLUTD it will make regular visits to its litter tray or outside to its favourite toilet area but without much success. There may be small amounts of dark or red (blood-stained) urine. Your cat may look as if it is straining and may cry out in pain or lick around its bottom or penis area.

The discomfort may cause changes in its toilet habits and a normally reliable cat may try to go to the toilet in the wrong place. If there is a total blockage of its tubes, pressure can build up in the bladder causing it to burst. Alternatively there may be kidney failure and poisons normally filtered out by the kidneys will build up in the blood.

Often the discomfort of FLUTD is mistaken for constipation. If you are in any doubt, assume FLUTD and consult your vet as soon as possible.

Your vet may need to take a urine sample to show the difference. An affected cat will have abnormalities such as crystals in the urine (mineral salts which cause bladder stones) or unusually concentrated urine. Blood samples will also show evidence of kidney damage if this has already occurred. An x-ray may help your vet to find the source of the blockage.

A complete blockage is an emergency and your vet will have to act fast. At first your cat may only seem mildly depressed with occasional vomiting but within 48 hours it could have lapsed into a coma and died.

Your cat will be sedated (or anaesthetised) and a tube (‘catheter’) inserted into its bladder to drain the trapped urine and relieve the pressure. Occasionally stones may be surgically removed. Less serious cases will be given pain killers and drugs to reduce the inflammation. Antibiotics may help get rid of any infection. Remember, only use the medicines recommended by your vet – some human drugs are poisonous to cats.

Encouraging your cat to drink plenty of water and adjusting its diet are the best ways of treating and preventing FLUTD.

You must make sure there is always clean, fresh water available. Ideally you should feed your cat moist food only and make your cat drink extra water by mixing one third of a cup of water with every meal for the rest of its life. The water should be mixed thoroughly with the food and allowed to stand for 10 minutes before feeding so that it takes up the flavour of the food.

There are special diets available from your vet which can reduce the risks of stones developing. Some cats may need daily medication to help keep their urine acid.

Cats are very choosy about their toilet habits and a dirty litter tray may make them hold on to their urine and this may be a factor in the formation of stones. If there are several cats in your household the affected cat should be encouraged to use its own litter tray. This will allow you to check how much urine it produces and spot signs of further problems as soon as they develop.

A healthy cat may take in between 20 and 90ml of water per kg of body weight per 24 hours. This figure includes the water in food, which obviously varies according to how much dry and how much canned/pouched food the cat has.

So it is not until your cat is drinking around 100ml of water per kg body weight (for an average cat this is around 300-400ml) per day that you can be sure this is excessive. However, most cats do not drink this much and for many a lesser intake may be significantly abnormal so if you notice any increase in the amount of water being drunk by your cat this may be the first indication of a problem and should not be ignored. Cats on dry diets will need to drink more than cats on moist food so if you have recently changed your cat’s diet this may be the reason for a change in drinking habits.

If you are worried about how much your cat is drinking you might want to try to measure their actual intake. The easiest way to do this is fill their bowl with a known volume of water using a jug and then at the end of the day measuring how much water is left. Of course, for many cats this is difficult as they drink outside, from sources other than their bowl and often share a water bowl with other animals. To measure the water intake in these cats you might have to isolate your cat and keep her indoors for three days.

If your cat is drinking more you may notice increased urination. Here we are most interested in an increase of the total volume of urine being produced. Again, this may not be noticed in cats that are outside for much of the day but, for other cats, owners may notice that the litter needs changing more often or that litter training is lost.

If your cat is visiting the litter tray more often this may not be due to an increase in urine volume. Often it will be due to increased urgency in urination caused by diseases of the bladder such as cystitis. These cats will usually pass only small volumes of urine, they may vocalise as they are irritated or in pain and there may be blood staining.

When cats are drinking more it is nearly always caused by a disease (either based in the kidneys or elsewhere in the body but affecting the kidneys secondarily) that is causing the kidneys to make dilute urine and the cat then has to drink to stop being thirsty. So it is actually usually the increased urine production that happens first and the increased drinking is to compensate.

In the vast majority of cats that are drinking excessively it is because they are genuinely thirsty as their kidneys are making more urine, their bodies are detecting the loss of fluid and stimulate the desire to drink. There are two main reasons for this: either there is a problem with a hormone that regulates the concentration of urine – this is best known as ADH (anti-diuretic hormone). It may be that there is not enough ADH being produced or it may be that the kidneys fail to react to the ADH. The second cause is that the urine contains large amounts of an abnormal substance that draws water out with it into the urine by a physical process called osmosis; an example is glucose (sugar) in the urine of a diabetic cat.

The commonest diseases that often show up as a cat drinking excessively are chronic kidney failure, diabetes mellitus and hyperthyroidism – but all these conditions may show in other ways, for example weight loss or changes in appetite and behaviour.

There are many other conditions that also have an increase in thirst and urination as part of their clinical signs:

• high blood calcium levels (hypercalcaemia)
• low blood potassium (hypokalaemia)
• bacterial infection in the kidneys (pyelonephritis)
• liver failure
• acromegaly and hyperadrenocorticism (each of which show with signs of diabetes mellitus),
• acute renal failure (especially in the recovery phase)
• diabetes insipidus
• renal glucosuria
• pyometra (infection in the uterus)
• hypoadrenocorticism and damage to the pituitary gland

Other possibilities that should be obvious but must be considered are certain drugs such as the diuretics often used to treat heart failure and some foods that are designed to promote water intake by being high in salt.

There are also important underlying diseases that must be considered. For example hypercalcaemia is often caused by cancers such as lymphoma and hypokalaemia might be caused by hyperaldosteronism (Conn’s syndrome).

Occasionally excessive thirst is the basic cause, and this is called primary polydipsia. It can be due to brain disease or a behavioural abnormality. In cats the commonest cause of primary polydipsia is probably as part of the common endocrine condition hyperthyroidism.

A veterinary surgeon will want to ask questions about your cat and examine her. Most of the causes of PU/PD will give other clues that they are present. If there is uncertainty about the extent of the problem then actually measuring the volume of water drunk (daily for about three days) and weighing your cat will allow your vet to assess if water consumption is excessive.

Most cats will require a combination of blood and urine tests as an initial investigation and the common causes of PU/PD are usually easily diagnosed or ruled out. Some cats will require a more in-depth investigation to uncover their problem, involving further blood tests, imaging with ultrasound or x-rays and the taking of biopsies.

One important point is that now many cats are living into old age it is quite common for them to have to cope with more than one condition and combinations such as chronic renal failure and hyperthyroidism need to be considered.

Finding out the cause of the excessive drinking is the priority so if you think your cat may be drinking more than usual an early visit to your vet is advisable. There will then be options for treatment. Not all options suit every cat and each owner but the conditions listed above can all be helped, to varying degrees. One thing that is common to all is that in no circumstances should water be withheld.

Cystitis means that the lining of the bladder is inflammed and is usually caused by an infection in the urine. Because the bladder is sore cats want to empty it more often and so are frequently seen squatting and trying to pass urine.

The first sign you will usually notice is your cat visiting the litter tray more frequently. When using a tray they may only pass small amounts of urine and sometimes you will see blood. Occasionally your cat will strain as if trying to pass urine but nothing comes out. In these cases cystitis may be mistaken for constipation or a blockage in the urinary system. Some cats with cystitis seem restless and unsettled and others will cry when straining to urinate.

Your vet will probably suspect that your cat has a problem with passing urine based on your description of the signs. However it is important to rule out other potential problems (such as a urinary tract blockage) before starting treatment. Your vet will first want to examine your cat and by feeling the bladder and other organs they may be able to get a good idea of what is going on.

Tests on a urine sample will show if there is anything wrong with the urine such as excess sugar, protein or crystals in the urine. If there is a problem then a urine sample may be sent to a laboratory to see if bacteria can be grown (cultured). If bacteria do grow there are tests that can be done to find the right antibiotics to clear up the infection.

If the problem keeps coming back or fails to clear up properly, your vet may advise that the bladder is examined using X-rays or ultrasound. If your pet has signs of general illness, such as fever or poor appetite, more general tests including blood tests are likely to be carried out.

The most common cause of cystitis in cats is stress. This can be an obvious stress, such as a new addition to the household or building work taking place, but some cats become stressed by even minor changes to their routine. Less common in cats is an infection caused by bacteria which usually gain entry to the body through the urethra (which is the tube leading from the bladder to the exterior).

There are a whole range of different problems which can make it more likely that your cat will develop cystitis due to infection. In some cases a bladder stone may have damaged the inside of the bladder. Cats which have problems emptying their bladder because they have a blockage or are unwilling to use their litter tray are also more at risk.

Sometimes there is another disease present that makes your cat less able to fight infection. Kidney disease can result in cystitis, and diabetic cats have a lot of sugar in their urine making the bladder an ideal place for bacteria to grow.

Your vet will be able to prescribe some drugs that help to relax the bladder and reduce the pain associated with passing urine. If your cat has a bacterial cystitis and there is no other obvious problem your vet may give you a course of antibiotics. In most cases the problem should start to clear up within a few days of starting the treatment.

It is very important that you continue to give the treatment until the course is finished, even if your cat seems completely better. If you stop treatment too early the problem may come straight back and the tablets may not work a second time.

Ensuring your cat can empty its bladder regularly will help to make them feel more comfortable. Make sure they have access to a clean litter tray at all times. Ideally there should be one more litter tray than the number of cats in the house.

Encourage your cat to drink plenty of fluids as this will help to dilute the urine and make it less irritant to the bladder. Cats generally prefer to drink from ceramic or metal bowls rather than plastic and you might consider getting a drinking fountain. Cats that are prone to cystitis should be fed a moist (tinned) diet as this encourages water intake and makes the urine more dilute.

If your cat suffers from stress related cystitis you need to try to keep their lives as stress free as possible! In addition the use of a pheromone diffuser may help.

Most cats recover very quickly from cystitis. However, if there is some other problem which has caused the cystitis then this must also be cleared up or the cystitis will come straight back. If cats have an underlying cause for the cystitis which cannot be resolved, then they may occasionally need to be on permanent medication for stress, or recurring courses of antibiotics.

Autosomal dominant polycystic kidney disease (known as AD-PKD) is an inherited condition that can cause severe kidney failure in cats. The disease causes small, fluid filled holes (cysts) to form in the kidney, and these gradually get larger as the cat gets older. As the cysts get bigger the kidneys are unable to work normally and kidney failure will eventually occur, but the time course of this is very variable.

The disease is caused by an abnormal gene. All cats with the abnormal gene will develop the disease but because the signs of disease usually do not develop until the cat is adult it is possible for a cat to breed extensively (and pass the disease on to its kittens) before the affected cat becomes ill. It is therefore essential to screen breeding cats of high risk breeds for the presence of the gene before they are used for breeding.

Cats with PKD have progressive kidney disease that will ultimately lead to kidney failure. The disease cannot be treated but if your cat does develop renal failure, there are some treatments that may help to improve its quality of life. Sadly the disease is ultimately fatal. The only way to prevent future cats suffering the same fate is to make sure that affected cats are not allowed to breed.

PKD is an inherited disease passed from parents to offspring in the genes. The affected gene is an autosomal dominant gene, so it affects both males and females; only one of the parents needs to have the disease for it to be passed onto some of the kittens, and all cats that inherit even a single copy of the affected gene will be affected by PKD.

PKD is a very rare condition in breeds other than those that are, or are related to, Persians and Exotic shorthairs. Persian cats throughout the world appear to have an especially high chance of having PKD. Recent figures show that 1/3 of Persians cats in the UK are affected, and numbers are similar throughout the world.

Other breeds, related to Persians, are also at high risk of the disease. The disease is common in Exotic shorthairs, with 3 in 10 testing positive for PKD. Other breeds which may have imported the PKD gene through previous outcrosses with Persian cats include British shorthairs, Burmillas and possibly Maine Coons.

Cats can be screened for the presence of disease before they start to show signs of kidney failure. Breeding cats from the high-risk breeds should be screened for AD-PKD before they are used for breeding. If your cat belongs to one of the breeds at risk of AD-PKD then it may well have come with some sort of certification from the breeder and if both its parents are free of the disease then it will not have disease.

If your cat is in a high-risk breed group and its parents have not been tested then you can arrange for a gene test to be done. The test uses DNA extracted from a swab taken from inside the cat’s mouth, or from a blood sample. Cats over 10 months of age can also be screened for the disease by ultrasound scanning.

The gene test for ADPKD involves collections of cells from the cat’s mouth, or from a blood sample. The sample is then sent to one of the accredited laboratories offering the gene test. There are two accredited laboratories in the UK (Langford Veterinary Diagnostics and the Animal Health Trust) and many breeders also use the lab in the USA where the test was developed (Veterinary Genetics Laboratory, University College, Davis, California).

In order to qualify for entry on the AD-PKD Negative Register cats must also have an identification microchip, the number of which must be recorded by a vet on the submission form which accompanies the sample to the lab.

Ultrasound scanning can be used to identify the kidney cysts. If the cysts are large they can easily be identified by routine scanning (just like pregnancy testing in humans) and this is useful in cats with advanced PKD, e.g. those that have enlarged kidneys, or that have already developed renal failure. A small patch of fur will need to be clipped so that the ultrasound can get good contact with the skin.

Pre-breeding screening requires a more specialist approach as the cysts are likely to be very tiny and hard to identify. The scan must be done by a specialist ultrasonographer using a very high definition machine. Cats must be 10 months old before they can be given a certificate to say that they do not have PKD, because the cysts may be too small to detect before this time.

To qualify for entry on the AD-PKD Negative Register the cat must be scanned by an approved ultrasonographer and must have an identification microchip which can be read at the time of scanning so that its identity can be checked.

For breeding cats the ultrasound test for PKD must be done by a specialist ultrasonographer (so that you can be sure that the result is accurate). If you would like your negative cats to be included on the AD-PKD Negative Register your vet will be able to refer you to an accredited specialist.

If you are not planning to breed from your cat, your own veterinarian may be able to scan your cat and tell you whether or not your cat has large kidney cysts.

Reputable breeders of Persian and Exotic shorthaired cats will have all their breeding cats tested for PKD. If both parents are free of disease the offspring will all be unaffected. Occasionally a breeder may need to have a litter of kittens from an affected cat, and in this case it is predicted that a proportion of the kittens may be unaffected. The kittens can therefore be gene tested to identify which of them have the disease, and which have not.

International Cat Care runs an AD-PKD Negative Register listing cats that have been verifiably tested to AD-PKD and have been found to be negative.

International Cat Care (formerly the Feline Advisory Bureau – FAB) has all the up to date information about the disease and the AD-PKD Negative Register. For further information contact:

International Cat Care
High Street
Tisbury
Wiltshire
SP3 6LD
United Kingdom

Tel: 01747 871 872
Fax: 01747 871 873
Email: info@icatcare.org
Web: icatcare.org